Incontinence

Question 1

What questions would you like to ask?

Answer 1

Frequency of going to the bathroom?
Urgency?
Nocturia?
Weak stream?
Intermittent?
Straining
Emptying?

Any leaks? Any triggers

Question 2

What are the red flag symptoms that you want to look out for

Why?

Answer 2

Bladder or prostate cancer

• unexplained weight loss
• fatigue
• night sweats

Pyelonephritis, hydronephrosis, AKI/CKD

• fever
• back pain
• haematuria, dysuria

Question 3

What is stress incontinence

• symptoms
• management

Answer 3

Intraabdominal pressure exceeds pelvic floor strength => trickles
-triggered by sneeze, cough

Multigravid
Obesity
Pelvic surgery

No medical management
First line => pelvic floor training, lifestyle changes (weight loss, medication optimisation, caffeine, smoking cessation, improved glucose control, diuretics)
Second line => surgery (colposuspension, sling)

Question 4

What is urge incontinence

• symptoms
• management

Answer 4

Detrusor hyperactivity

Frequent, urgent trips
Nocturia
Low flow

NO SURGICAL MANAGEMENT
First line => Bladder retraining
Second line => Lifestyle changes (weight loss, smoking cessation, medication optimisation, improve glucose control, diuretics, caffeine)
-incontinence pads
Third line => Medication
-antimuscarinic (toltoredine, oxybutinin)
-B3 agonist (mirabegron)

Question 5

What is overflow incontinence

• symptoms
• management

Answer 5

Harder to pass urine due to physical blockage or detrusor under activity

Abdominal pain
Intermittent, weak stream
Incomplete emptying
Frequent trips

May present as infection, CKD, AKI

First line => address underlying cause

• BPH (a1 blocker, surgical intervention)
• Cancer (chemo, radio, surgical)

Question 6

How would you assess bladder volumes
At what volume would you feel the need to go to the bathroom
At what volume would you be in urinary retention

Answer 6

Bladder scanner

At 200ml => urge to go
At 500ml => urinary retention